Unifying Concepts

Diagnostic Criteria for Premenstrual Syndrome (PMS)

Premenstrual disorders consist of psychiatric or somatic symptoms that develop within the luteal phase of the menstrual cycle, affect the patient’s normal daily functioning, and resolve shortly after menstruation. The luteal phase begins after ovulation and ends with the start of menstruation. The American Congress of Obstetricians and Gynecologists (ACOG) includes psychiatric and physical symptoms in describing premenstrual syndrome (PMS).

Diagnostic Criteria for Premenstrual Syndrome

Premenstrual syndrome can be diagnosed if the patient reports at least one of the following affective and somatic symptoms during the five days before menses in each of the three previous menstrual cycles*

A- Affective symptoms

  • Angry outbursts
  • Anxiety
  • Confusion
  • Depression
  • Irritability
  • Social withdrawal

B- Somatic symptoms

  • Abdominal bloating
  • Breast tenderness or swelling
  • Headache
  • Joint or muscle pain
  • Swelling of extremities
  • Weight gain

These symptoms must be relieved within four days of the onset of menses, without recurrence until at least day 13 of the cycle, and must be present in the absence of any pharmacologic therapy, hormone ingestion, or drug or alcohol use. The symptoms must occur reproducibly during two cycles of prospective recording. The patient must exhibit identifiable dysfunction in social, academic, or work performance.



  1. Hofmeister S, Bodden S. Premenstrual Syndrome and Premenstrual Dysphoric Disorder. Am Fam Physician. 2016;94(3):236-240. [Medline]
  2. Appleton SM. Premenstrual Syndrome: Evidence-based Evaluation and Treatment. Clin Obstet Gynecol. 2018;61(1):52-61. [Medline]


Created Sep 11, 2020.



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